Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany.
Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany.
PLoS One. 2019 Feb 21;14(2):e0212007. doi: 10.1371/journal.pone.0212007. eCollection 2019.
Eye-drop administration errors occur in the majority of patients and increase the risk for treatment failure or systemic adverse events. While lacking knowledge is the principal error cause, most patients overestimate their skills and are unaware of often substantial knowledge gaps. Therefore, the impact of including motivational patient education on long-term eye-drop administration skills of patients was investigated.
This is a cluster-randomized controlled trial in German community pharmacies. Patient education in both groups comprised observation of the patient during eye-drop administration to identify individual errors, pharmaceutical counseling, and teach-back evaluation of the training. In the intervention group, motivational communication techniques were included to increase error awareness and readiness for patient education. In addition, intervention patients were trained on repeated errors until administration was performed correctly. In contrast, patients in the control group only received feedback on erroneous administration steps without another assessment and reinforced training.
In total, 152 adult patients were eligible to the study and 91 patients (intervention group N = 46) agreed to participate in a 1-month, 6-month, and 12-month follow-up. Patient education significantly increased the proportion of patients correctly administering eye-drops from 6% (7 out of 56 intervention patients, 1 out of 82 control patients) at baseline to 35% (12 out of 30 intervention patients, 12 out of 39 control patients, p ≤ 0.001) at the 1-month follow-up, and 64% (11 out of 15 intervention patients, 17 out of 29 control patients, p ≤ 0.001) at the 6-month follow-up irrespective of group allocation. In some patients previously resolved errors recurred during follow-up visits. This emphasizes the need for periodical reevaluation of patient administration skills and the provision of prevention strategies besides education.
Patient education that included demonstration of administration skills and verbal and written counseling on observed errors improved eye-drop administration skills irrespective of the communication technique applied. Whereof, high drop-out rates limited the power to detect a difference between groups. In particular, periodic demonstration of administration skills seemed important for sustainable improvement of administration skills. However, further error prevention strategies such as additional education materials or support by a caregiver may be necessary in some patients.
滴眼液给药错误在大多数患者中发生，并增加治疗失败或全身不良事件的风险。虽然缺乏知识是主要的错误原因，但大多数患者高估了自己的技能，并且不知道自己经常存在大量的知识差距。因此，研究了将动机性患者教育纳入长期滴眼液给药技能对患者的影响。
这是一项在德国社区药房进行的集群随机对照试验。两组患者的教育均包括在滴眼液给药期间观察患者以识别个体错误、药物咨询以及对培训的回述评估。在干预组中，纳入了动机沟通技巧以提高错误意识和接受患者教育的准备度。此外，对干预组患者进行了重复错误的训练，直到给药正确为止。相比之下，对照组患者仅对错误给药步骤提供反馈，而不进行其他评估和强化培训。
共有 152 名成年患者符合研究条件，91 名患者（干预组 N = 46）同意参加为期 1 个月、6 个月和 12 个月的随访。患者教育显著增加了正确滴眼的患者比例，从基线时的 6%（干预组 56 名患者中的 7 名，对照组 82 名患者中的 1 名）增加到 1 个月随访时的 35%（干预组 30 名患者中的 12 名，对照组 39 名患者中的 12 名，p ≤ 0.001），并在 6 个月随访时增加到 64%（干预组 15 名患者中的 11 名，对照组 29 名患者中的 17 名，p ≤ 0.001），而与分组无关。在一些患者中，以前解决的错误在随访期间再次出现。这强调了需要定期重新评估患者给药技能，并提供除教育以外的预防策略。
包括演示给药技能以及对观察到的错误进行口头和书面咨询的患者教育，改善了滴眼液给药技能，而不论应用的沟通技巧如何。其中，较高的脱落率限制了检测组间差异的能力。特别是，定期演示给药技能似乎对持续改善给药技能很重要。然而，在一些患者中，可能需要额外的教育材料或护理人员的支持等其他错误预防策略。
